Provider Demographics
NPI:1922334002
Name:SUNCOAST NEUROPSYCHOLOGY LLC
Entity Type:Organization
Organization Name:SUNCOAST NEUROPSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:813-633-6000
Mailing Address - Street 1:235 APOLLO BEACH BLVD # 506
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-2251
Mailing Address - Country:US
Mailing Address - Phone:813-633-6000
Mailing Address - Fax:813-633-0438
Practice Address - Street 1:833 CYPRESS VILLAGE BLVD
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33573-6822
Practice Address - Country:US
Practice Address - Phone:813-633-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7611103G00000X, 103T00000X, 103TA0700X, 103TC0700X, 103TF0200X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Multi-Specialty